BACKGROUND: Addressing chronic low back pain (cLBP) from the point of view of representation allows better understanding the behaviors associated with it and thus improve its medical and ...socio-occupational management. The Quebec Questionnaire of Representations related to Work Disability (QRWoD) proposes an evaluation of 9 dimensions of the cLBP-related representation. OBJECTIVE: To translate and adapt the QRoWD to French language and assess its validity and reliability in French cLBP workers on prolonged sick leave. METHODS: A prospective study was conducted from March 2017 to April 2018 in the Department of occupational health of the University Hospital of Angers, France. The QRWoD is a self-administered questionnaire (87 items) which assesses Identity, Acute/Chronic duration, Consequences, Personal Control, Treatment Control, Cyclical Timeline, Coherence, Emotional Representation and Causes dimensions. The Internal consistency (Cronbach’s α) and the convergent validity (Pearson correlations) in comparison to validated instruments for each dimension were assed. RESULTS: Fifty French workers (29 men, 43 ± 9.1 years, 293.6 ± 173.0 days of work absence) were included. The internal consistency (all α> 0.7) and the convergent validity (all r2> 0.25, p< 0.01) of each dimension were very satisfactory except for the Cyclical Timeline dimension. CONCLUSIONS: The French version of the QRoWD seems to be valid and relevant among the target population.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Therapy with oral anticoagulation (OAC) can be challenging, especially in high risk groups such as chronic patients. Gaps in patient knowledge about OAC are linked to reduced effectiveness and safety ...of treatment. The objectives of this study were i) to assess OAC knowledge gathered during an intermediate medication review (MR) in patients taking vitamin K antagonists (VKA) or non-vitamin K antagonist oral anticoagulants (NOAC); ii) to assess OAC knowledge two weeks after the MR, and iii) to evaluate patient satisfaction with the MR service in community pharmacies.
Chronic OAC patients were invited for a regular MR service in Swiss community pharmacies, the so-called "Polymedication-Check" (PMC). OAC knowledge was assessed with seven newly generated items asked face-to-face during a PMC and by telephone two weeks later. Knowledge gaps, pharmacists' spontaneous interventions, and patient satisfaction were documented by observing pharmacy students. Treatment groups were compared.
Of all patients (n = 81), the number of patients with one or more knowledge gaps decreased from 66% to 31.3% after PMC (
< 0.001). NOAC patients (n = 31) had more knowledge gaps than VKA patients (n = 50;
< 0.05). Most patients (98.6%) were satisfied with the counselling provided by the pharmacists.
The majority of chronic OAC patients shows knowledge gaps. Although spontaneous, the provision of tailored education during a PMC increased patient OAC knowledge.
Non-adherence to direct oral anticoagulants (DOACs) remains a matter of concern, especially for patients with a recent stroke. However, data on electronically monitored adherence and ...adherence-improving interventions are scarce.
We aim to use electronic monitoring in DOAC-treated stroke patients to (i) evaluate the effect of an educational, reminder-based adherence-improving intervention, (ii) investigate predictors of non-adherence, (iii) identify reliable self-report measures of adherence, and (iv) explore the association of non-adherence with clinical outcomes.
Single-center, randomized, crossover, open-label study. Adherence to DOACs of polymedicated patients self-administering their medication will be monitored electronically throughout the 12-month-long study following hospitalization for ischemic stroke. After a 6-month observational phase, patients will receive pharmaceutical counseling with feedback on their intake history and be given a multi-compartment pillbox for the subsequent 6-month interventional phase. The pillbox will provide intake reminders either during the first or the last three interventional-phase months. Patients will be randomly allocated to reminders-first or reminders-last.
Primary: non-optimal timing adherence; Secondary: non-optimal taking adherence; timing adherence; taking adherence; self-reported adherence; clinical outcomes including ischemic and hemorrhagic events; patient-reported device usability and satisfaction.
A sample of 130 patients provides 90% power to show a 20% improvement of the primary adherence outcome with intake reminders.
MAAESTRO will investigate various aspects of non-adherence and evaluate the effect of an adherence-improving intervention in DOAC-treated patients with a recent stroke using electronic monitoring.
ClinicalTrials.gov identifier: NCT03344146, Swiss National Clinical Trials Portal SNCTP000002410.
: Transitions of care are high-risk situations for the manifestation of medication discrepancies and, therefore, present threats for potential patient harm. Medication discrepancies can occur at any ...transition within the healthcare system.
: Fifth-year pharmacy students assessed a best possible medication list (BPML) during a medication review (based on medication history and patient interview) in community pharmacies. They documented all discrepancies between the BPML and the latest medication prescription. Discrepancies were classified using the medication discrepancy taxonomy (MedTax) classification system and were assessed for their potential clinical and economic impact.
Overall, 116 patients with a mean age and medication prescription of 74 (± 10.3) years and 10.2 (± 4.2), respectively, were analyzed. Of the 317 discrepancies identified, the most frequent type was related to strength and/or frequency and/or number of units of dosage form and/or the total daily dose. Although, the majority of discrepancies were rated as inconsequential (55.2%) on health conditions, the remainder posed a potential moderate (43.2%) or severe impact (1.6%). In 49.5% of the discrepancies, the current patients' medication cost less than the prescribed.
: Community pharmacies are at a favorable place to identify discrepancies and to counsel patients. To improve patient care, they should systematically perform medication reconciliation whenever prescriptions are renewed or added.
Workplace absenteeism is still a curse for developed countries, and more systematic practices need to be adopted to address this issue.
To review the literature on best practices for managing work ...absences related to musculoskeletal or common mental disorders.
A review was conducted by performing a search in bibliographic databases and on work-disability research institute websites. Recommendations regarding work-absence management and return-to-work practices were extracted from all the retained documents and organized within a chronological framework.
In total, 17 documents were analyzed, leading to identification of common work-absence management and return-to-work practices, the importance of a worker support approach, and recommended roles and responsibilities for stakeholders. These practices were then integrated into a six-step process: (1) time off and recovery period; (2) initial contact with the worker; (3) evaluation of the worker and his job tasks; (4) development of a return-to-work plan with accommodations; (5) work resumption, and (6) follow-up of the return-to-work process.
Based on this review, we constructed a comprehensive work-absence management and return-to-work process designed to assist organizations. Our results indicate that such a process must be included within a broader policy of health promotion and job retention. Adaptations will be required for implementation in the workplace.
The developmental mechanisms through which the cerebral cortex increased in size and complexity during primate evolution are essentially unknown. To uncover genetic networks active in the developing ...cerebral cortex, we combined three-dimensional reconstruction of human fetal brains at midgestation and whole genome expression profiling. This novel approach enabled transcriptional characterization of neurons from accurately defined cortical regions containing presumptive Broca and Wernicke language areas, as well as surrounding associative areas. We identified hundreds of genes displaying differential expression between the two regions, but no significant difference in gene expression between left and right hemispheres. Validation by qRTPCR and in situ hybridization confirmed the robustness of our approach and revealed novel patterns of area- and layer-specific expression throughout the developing cortex. Genes differentially expressed between cortical areas were significantly associated with fast-evolving non-coding sequences harboring human-specific substitutions that could lead to divergence in their repertoires of transcription factor binding sites. Strikingly, while some of these sequences were accelerated in the human lineage only, many others were accelerated in chimpanzee and/or mouse lineages, indicating that genes important for cortical development may be particularly prone to changes in transcriptional regulation across mammals. Genes differentially expressed between cortical regions were also enriched for transcriptional targets of FoxP2, a key gene for the acquisition of language abilities in humans. Our findings point to a subset of genes with a unique combination of cortical areal expression and evolutionary patterns, suggesting that they play important roles in the transcriptional network underlying human-specific neural traits.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction and hypothesis
In this study we described a new technical approach to adapt endovaginal ultrasound scanning of the anal sphincter complex to the immediate postpartum period.
Methods
We ...analyzed the clinical and ultrasonographic examinations of 18 primiparous women presenting deep perineal tears with potential or clearly identified lesions of the anal sphincter. Potential anal sphincter lesion was defined as a second degree perineal tear extending close to the anal sphincter with exposition of its capsule or muscular fibers. We reported interesting ultrasonographic images explaining our technique in a video.
Results
We reported clinical and ultrasonographic features in nine cases of grade 2, four cases of grade 3a, four cases of grade 3b and one case of grade 3c perineal tears. The ultrasonographic examination confirmed the intact state of the anal sphincter complex in all patients with clinical grade 2 tears except one in which a grade 3b lesion was detected. We were not able to identify external anal sphincter lesions on ultrasound in any of the patients with clinical grade 3a tears. In patients with clinical grade 3b tears, the ultrasound confirmed the external anal sphincter lesion in all cases, but revealed additional involvement of the internal anal sphincter in 1 case (grade 3c).
Conclusion
Immediate postpartum endovaginal ultrasound could be a promising technique to improve the management of perineal traumas after vaginal delivery.
Introduction and hypothesis
Obstetric anal sphincter injuries are frequently missed and carry a significant risk for the development of anal incontinence. Immediate postpartum endoanal ultrasound ...increases identification of these injuries but is rarely employed. We hypothesize that endovaginal ultrasound could be a feasible and easily available alternative sonographic tool to improve early diagnosis of anal sphincter tears.
Methods
We conducted a prospective experimental study including 160 primiparous women. Shortly after vaginal delivery, patients underwent clinical and sonographic perineal examinations. We analyzed the feasibility of anal sphincter assessment by endovaginal ultrasound and its potential contribution in the early diagnosis of anal sphincter injuries.
Results
Sonographic assessment of the anal sphincter was analyzable for 136 patients (85.0%). Causes of non-analyzability included air artifacts (6.9%), lack of distinction between the external anal sphincter and surrounding tissues (9.4%) and distortion artifacts (9.4%). Patients in the non-analyzable ultrasound subgroup were less likely to have delivered in a dorsal lithotomy position (62.5% vs. 85.3 %) and more likely to have had an episiotomy (33.3% vs. 14.0%), and their risk of sphincter injury was more frequently classified as “improbable” on clinical examination (91.7% vs. 61.0%). Ultrasounds were analyzable for 96.4% of patients clinically reported as having “possible” or “certain” sphincter injuries. The incidence of anal sphincter injury was 16.9% for clinical observation and 20.0% with associated sonographic examination.
Conclusions
Endovaginal ultrasound could be used as a complementary tool in assessment of the anal sphincter in high-risk patients. Its feasibility and easy availability make this technique a promising tool for improving the management of anal sphincter tears.
Background
Direct oral anticoagulants (DOAC) effectively prevent recurrent ischaemic events in atrial fibrillation (AF) patients with recent stroke. However, excellent adherence to DOAC is mandatory ...to guarantee sufficient anticoagulation as the effect quickly subsides.
Aim
To investigate the effect of intake reminders on adherence to DOAC.
Methods
MAAESTRO was a randomised, cross-over study in DOAC-treated AF patients hospitalised for ischaemic stroke. Adherence was measured by electronic monitoring for 12 months. After an observational phase, patients were randomised to obtain an intake reminder either in the first or the second half of the subsequent 6-month interventional phase. The primary outcome was
100%-timing adherence
. Secondary outcomes were
100%-taking adherence
, and overall timing and taking adherence. We analysed adherence outcomes using McNemar’s test or mixed-effects logistic models.
Results
Between January 2018 and March 2022, 130 stroke patients were included, of whom 42 dropped out before randomisation. Analysis was performed with 84 patients (mean age: 76.5 years, 39.3% women). A
100%-timing adherence
was observed in 10 patients who were using the reminder, and in zero patients without reminder (
p
= 0.002). The reminder significantly improved adherence to DOAC, with study participants having 2.7-fold increased odds to achieve an alternative threshold of
90%-timing adherence
(OR 2.65; 95% CI 1.05–6.69;
p
= 0.039). A similar effect was observed for
90%-taking adherence
(OR 3.06; 95% CI 1.20–7.80;
p
= 0.019). Overall timing and taking adherence increased significantly when using the reminder (OR 1.70; 95% CI 1.55–1.86,
p
< 0.01; and OR 1.67; 95% CI 1.52–1.84;
p
< 0.01).
Conclusion
Intake reminders increased adherence to DOAC in patients with stroke attributable to atrial fibrillation.
Trial registration
ClinicalTrials.gov: NCT03344146.
PDF
